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July 19, 2018 -- After uncovering massive backlogs of imaging examinations at three hospitals in England, the Care Quality Commission has highlighted the need for immediate action in its comprehensive new review of radiology reporting, but Royal College of Radiologists President Dr. Nicola Strickland has renewed her plea for more resources.

In the review, released on 19 July, the commission revealed that there was huge variation in reporting times among the National Health Service (NHS) trusts (hospital groups) in England, even at facilities that consistently monitored turnaround times and performance. This finding highlighted the lack of clear national standards as one of the chief barriers to timely reporting.

"Our report calls for action to address these issues, which have gone under the radar for far too long," noted Dr. Ted Baker, chief inspector of hospitals for the Care Quality Commission (CQC), the independent regulator of health and social care in England. "Action needs to be taken now to help minimize the risks to patients and make sure that patient examinations are reported on in a timely way by an appropriately trained healthcare professional."

A national affair

The deepening staffing crisis for U.K. radiology posts in recent years, along with the discovery of a backlog of more than 23,000 radiology exams at the Queen Alexandra Hospital in Portsmouth, prompted the CQC to investigate the status of radiology reporting at 151 acute and 18 community NHS trusts in England.

After assessing the trusts, the commission found that the issues with reporting were not unique to a particular set of hospitals but were, rather, rampant throughout all of the trusts. The commission flagged several key issues hindering effective reporting.

The first problem was the lack of clear national standards against which NHS trusts could compare themselves. Without a proper benchmark, clinicians at the trusts are unclear about what "good" reporting looks like, according to the CQC. This could explain the gaping variation in reporting times and monitoring methods.

Having a defined set of key performance indicators helped several trusts to oversee reporting more efficiently, know when to escalate backlogs to senior management, and drive improvements in the service, the commission noted. Yet without a national standard, even these local measures often led to delayed reporting.

Another major area of concern mentioned by the CQC was the widespread vacancies in the radiology workforce; the average vacancy rate was 14%. The ongoing failure of NHS trusts to recruit and retain radiologists has negatively affected reporting for years.

Common options for minimizing backlogs have been outsourcing and reporting of imaging exams by nonradiology staff. However, these alternatives have disadvantages of their own, and require oversight.

"Trusts should also be able to assure themselves that any reporting that is outsourced or delegated to nonradiology clinical staff is being reviewed by clinicians who are appropriately trained and competent to perform the task," Baker wrote.

Work together

Though the commission acknowledged that it had no singular solution for these issues, it offered a number of recommendations geared toward reducing the potential health risks to patients, including the following:

NHS trust boards should maintain oversight of any backlog of radiology reports, assess and manage risks to patients, and use staffing and other resources effectively.

The National Imaging Optimization Delivery Board should facilitate the development of national standards for report turnaround times.

The U.K. Royal College of Radiologists (RCR) and the Society and College of Radiographers should help develop frameworks to manage turnaround times safely.

RCR President Dr. Nicola Strickland.

In a response to the CQC report, the RCR commended the commission for urging the preparation of national standards for radiology reporting times. Though the college agreed that this would help support high-quality, uniform service for patients, it also questioned the achievability of creating standards that balance the optimization of turnaround times with the realities of struggling imaging teams.

"With those practicalities in mind, the RCR is keen to work with NHS Improvement on what viable national standards might look like," RCR President Dr. Nicola Strickland stated in the response. "The RCR also wants trusts to go a step further and routinely publish their reporting workloads and backlogs on a weekly basis to ensure large backlogs no longer go unnoticed or unchallenged."

Even with these efforts, backlogs will likely continue and patients will suffer, unless the underlying problem of a shortage in the radiology workforce is resolved, Strickland continued.

"Efficiencies will only get us so far, and most have already been made by radiology departments, due to the relentless pressure to improve reporting turnaround," she said. "There is no getting away from the fact that, to fulfill the CQC's recommendations and give patients the service they deserve, we need more radiologists."